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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREiT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wtivw.everettwa.org <br />APPLICATIONS AI2E ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITEMORE55 � <br />3/ �'i.�� <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />�`�� �/ �� <br />TENANTNAME <br />PARCEL TAX I.D, ft <br />TRACT <br />CONTACT <br />�� <br />CONTRACTOR ADDRESS CRy/ZJp <br />,C/)o¢t,�s s�!`JlC. E- �/dt/.� /��� <br />CONTR. LICENSE N . s��� ��I•(�C� Kf-� � <br />USE OF BUILOING <br />WORK O�SCRIPTION <br />NO. � TYpE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash Basin) <br />Shower <br />Kitchen sink $ dicposal <br />Dishwasher <br />Gothes washer <br />Laundry tray <br />5ink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountsin <br />Flaor drain <br />Grease trep <br />Root drains <br />Olhe� <br />U L� � <br />HEATSOURCE <br />� Electric _ Gas ` Other <br />PERMIT M <br />Z S� rZ <br />PHONE <br />� ZS <br />3 �1- <br />CONTRACT PWCE OF WORK <br />NO. � 7YPE OF FIXil1qE OR ITEbI <br />Fvc — air nanaiing units <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas fireplaco <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit hwte� <br />6oiler <br />Refrigeration <br />WoodsWva <br />Other <br />CITY OF EVERE77 LOCAL SALES TA% CODE 13 3105 <br />I hereby ceri�ify :hat I have read and axamined this applicatlon and know the same to be Vue and cortect All provisions of laws and <br />orainaces governing this rype of work will be complietl with whether specifled herein or not The qranting of a pertnit does not presume <br />to glve author'ty to violate or cancel the provislon of any other state or local law regulaung consVuction or lhe per(ortnanca of <br />eonstrudion. That I am authorizad Cy the owner of this proper.y to peAorm the work for which application is made and I ccmply wlth the <br />State Contractors Lawj,B,27 RCW and 296.20� WAC. <br />T00/TOO�j <br />d - L -af� � <br />ate � <br />. <br />� �� �I <br />.['idd:1S 9U7fi \M1"I3HJ �IF"I ZS98 189 BOS TV3 9Z�ST 90/CZ/OT <br />